The
World Health Organization (WHO) has published new “Guidelines on management of
physical health conditions in adults with severe mental disorders”.
Severe
mental disorders have been defined as a group of conditions that include
moderate to severe depression, bipolar disorder, and schizophrenia and other
psychotic disorders.
While
unnatural causes of death such as accidents, homicides or suicides are higher
in this group of patients than the general population, most deaths are due to
physical disease conditions such as diabetes, heart disease, TB, HIV/AIDS,
hepatitis B and C. These guidelines intend to provide evidence-based,
up-to-date recommendations to practitioners on how to recognize and manage
comorbid physical and mental health condition including risk factors such as
tobacco, overweight and obesity, .
Some
key recommendations include:
Tobacco
cessation
·
In people with severe mental disorders, combined pharmacological and
non-pharmacological interventions and/or a directive and supportive behavioural
intervention programme may be considered and should be tailored to the needs of
the population
Weight
management
·
Behavioural “tailored” lifestyle (healthy diet, physical activity)
interventions should be considered in all people with severe mental disorders
who are overweight or obese or at risk of becoming overweight or obese.
·
In this patient group, where lifestyle interventions and/or switching
psychotropic medication do not appear successful, adjunctive metformin may be
considered under close clinical supervision and monitoring.
Substance
use disorders
·
For people with severe mental disorders and comorbid substance use
disorders (drug and/or alcohol), interventions should be considered in
accordance with the WHO Mental Health Gap Action Programme (mhGAP) guidelines.
·
Non-pharmacological interventions (e.g. motivational interviewing) may be
considered and tailored to the needs of the people.
Cardiovascular
disease and cardiovascular risk
·
Behavioral lifestyle (healthy diet, physical activity) interventions and/or
collaborative care i.e. a multi-professional approach to patient care with a
structured management plan, scheduled patient follow-up, and enhanced
inter-professional communication is recommended for cardiovascular
disease management.
·
For people with severe mental disorders and cardiovascular risk factors,
behavioural “tailored” lifestyle (healthy diet, physical activity)
interventions may be considered. These interventions should be appropriate and
tailored to the needs of this population.
Diabetes
mellitus
·
Behavioral “tailored” lifestyle interventions should be considered for all
people with severe mental disorders and diabetes mellitus.
·
In people with depression and comorbid diabetes mellitus, cognitive
behaviour therapy for treatment of depression may be considered.
HIV/AIDS
·
For people with severe mental disorders and HIV/ AIDS, antiretroviral drugs
should be considered in accordance with the WHO Updated recommendations on
first-line and second-line antiretroviral regimens.
·
Additional psychosocial support for treatment adherence should be provided
in accordance with the WHO consolidated guidelines on the use of antiretroviral
drugs for treating and preventing HIV infection.
Other
infectious diseases (TB, Hepatitis B/C)
·
For people with severe mental disorders and TB, non-pharmacological
(social, psychological) and pharmacological management should be considered in
accordance with the WHO guidelines for the treatment of drug-susceptible TB and
patient care and the WHO treatment guidelines for drug-resistant TB.
·
For people with severe mental disorders and hepatitis B, treatment should
be considered in accordance with the WHO guidelines for the prevention, care
and treatment of persons with chronic hepatitis B infection.
·
For people with severe mental disorders and hepatitis C, treatment should
be considered in accordance with the WHO guidelines for the screening care and
treatment of persons with chronic hepatitis C infection.
(Source:
Guidelines for the management of physical health conditions in adults with
severe mental disorders. Geneva: World Health Organization; 2018)
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical
Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA
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